Corneal Cross-Linking in Keratoconus Using the Standard and Rapid Treatment Protocol: Differences in Demarcation Line and 12-Month Outcomes
Corneal Cross-Linking in Keratoconus Using the Standard and Rapid Treatment Protocol: Differences in Demarcation Line and 12-Month Outcomes
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DOI：
10.1167/iovs.14-15444
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发表时间：
2014-12-01
影响因子：
4.4
通讯作者：
Frueh, Beatrice E.
中科院分区：
文献类型：
--
作者：
Brittingham, Sara;Tappeiner, Christoph;Frueh, Beatrice E.
目的。比较两种不同治疗方案下圆锥角膜交联术（CXL）后分界线的发生率、深度及地形学结果。对131例进展性圆锥角膜行核黄素联合UV-A治疗的患者进行回顾性分析。采用标准德累斯顿方案（30分钟照射，3mw /cm(2), UV-XTM 1000）或快速方案（10分钟照射，9mw /cm(2), UV-XTM 2000）对眼睛进行治疗。在CXL术后1个月，由蒙面观察者用前段光学相干断层扫描设备评估角膜分界线的存在和深度。在基线和12个月的随访中，使用Pentacam和TMS（地形建模系统）设备进行角膜地形图和断层扫描。在标准方案组中，76.5%（62/81）的治疗角膜在CXL后1个月出现分界线，而快速方案组中只有22%（11/50）的治疗角膜出现分界线（P < 0.0001）。快速方案组的分界线明显更浅（P = 0.004）。基线和CXL后12个月的角膜地形图值显示，标准方案组K-max平均变化为-0.76屈光度(D) (SD +/- 2.7)，而快速方案组K-max平均变化为+0.72 D (SD +/- 1.5) （P = 0.007）。快速CXL方案在CXL后1个月对分界线的发生和深度产生负面影响。我们的研究结果表明，CXL后1年的地形结果有负面影响。
PURPOSE. To compare the occurrence rate and depth of the demarcation line and topographical outcome after corneal cross-linking (CXL) for keratoconus using two different treatment protocols.METHODS. A retrospective analysis of 131 eyes with progressive keratoconus treated with CXL using riboflavin and UV-A was performed. Eyes were treated either with the standard Dresden protocol (30 minutes irradiation, 3 mW/cm(2), UV-XTM 1000) or a rapid protocol (10 minutes irradiation, 9 mW/cm(2), UV-XTM 2000). The presence and depth of the corneal demarcation line was assessed with an anterior segment optical coherence tomography device 1 month after CXL by a masked observer. Corneal topography and tomography was performed at baseline and at 12-month follow-up with Pentacam and the TMS (Topographic Modeling System) device.RESULTS. In the standard protocol group, 76.5% (62/81) of treated corneas revealed a demarcation line 1 month after CXL, whereas such a demarcation line was observed in only 22% (11/50) of eyes treated with the rapid protocol (P < 0.0001). The demarcation line was significantly more superficial in the rapid protocol group (P = 0.004). Corneal topography values between baseline and 12 months after CXL showed a mean change of -0.76 diopters (D) in K-max (SD +/- 2.7) in the standard protocol group versus a mean change of +0.72 D in K-max (SD +/- 1.5) in the rapid protocol (P = 0.007).CONCLUSIONS. The rapid CXL protocol negatively influences the occurrence and depth of the demarcation line 1 month after CXL. Our results show a negative effect on the topographical outcome 1 year after CXL.